2017-05-12T20:55:07-05:00 2016-06-30 990292355 KKDLY LLC 745 FORT ST STE 2100 HONOLULU HI 96813 990 2015-07-01 990149797 KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES KOKU 8087919400 2239 NORTH SCHOOL STREET HONOLULU HI 96819 DAVID DERAUF EXECUTIVE DIRECTOR 8087919400 2017-05-11 1 ALAN E KOBAYASHI P00370602 8085213962 2017-05-11 X 2015 2021-01-29 14:40:06Z DAVID DERAUF 2239 NORTH SCHOOL STREET HONOLULU HI 96819 13255417 0 X WWW.KKV.NET X 1972 HI KOKUA KALIHI VALLEY AND AFFILIATE ( THE "CENTER") WERE INCORPORATED IN THE STATE OF HAWAII IN MAY 1972 TO PROMOTE HEALTH AND TO PROVIDE COMPREHENSIVE FAMILY SERVICES IN THE KALIHI VALLEY COMMUNITY IN THE CITY & COUNTY OF HONOLULU,HAWAII. THE CENTER IS A FEDERALLY-QUALIFIED HEALTH CENTER THAT PROVIDES A BROAD RANGE OF HEALTH AND SOCIAL SERVICES TO A LARGELY MEDICALLY-UNDERSERVED IMMIGRANT POPULATION. 11 11 225 85 0 0 5884053 7170276 6102301 5652145 5784 6468 240687 420298 12232825 13249187 0 0 0 0 8563960 9099964 0 0 195347 3787791 4311797 12351751 13411761 -118926 -162574 16392462 16176234 2158100 2104446 14234362 14071788 TOGETHER WE WORK TOWARD HEALING, RECONCILIATION AND THE ALLEVIATION OF SUFFERING IN KALIHI VALLEY, BY SERVING COMMUNITIES, FAMILIES AND INDIVIDUALS THROUGH STRONG RELATIONSHIPS THAT HONOR CULTURE AND FOSTER HEALTH AND HARMONY. 0 0 10130266 6051451 SERVICES PERFORMED TO PROVIDE ACCESS TO MEDICAL, DENTAL AND SOCIAL SERVICES IN THE KALIHI VALLEY COMMUNITY. 10130266 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 51 0 1 225 1 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 HI X DALLYS VEGA CHIEF FINANCIAL OFFICE 8087919400 2239 NORTH SCHOOL STREET HONOLULU HI 96819 PUA AUYONG PRESIDENT 1.00 X 0 0 0 GRACE COBB DIRECTOR 1.00 X 0 0 0 KAREN KAY FOX DIRECTOR 1.00 X 0 0 0 EDWARD KEMPER SECRETARY 1.00 X 0 0 0 THOMAS KUSATSU TREASURER 1.00 X 0 0 0 RICKEY MURASHIGE DIRECTOR 1.00 X 0 0 0 DAVID NAKAMOTO DIRECTOR 1.00 X 0 0 0 RYAN LEONG VICE PRESIDENT 1.00 X 0 0 0 FALETASI ATONIO DIRECTOR 1.00 X 0 0 0 GEOFFREY PANG DIRECTOR 1.00 X 0 0 0 MICHAEL L WAGNER DIRECTOR 1.00 X 0 0 0 DAVID DERAUF EXECUTIVE DIRECTOR 40.00 X 156682 0 37582 DALLYS GLORIBELL VEGA CHIEF FINANCIAL OFFICER 40.00 X 81267 0 14564 JO AYERS CHIEF OPERATING OFFICER 40.00 X 71561 0 5148 LAURA DEVILBISS CLINICAL DIRECTOR 40.00 X 160534 0 18793 JONAS NAVICKAS PHYSICIAN 40.00 X 130253 0 21582 NATHAN TAN PHYSICIAN 40.00 X 111098 0 16714 MYA HLA PSYCHIATRIST, DIR OF BH 40.00 X 108486 0 24848 JASON HIRAMOTO DENTAL DIRECTOR 40.00 X 116330 0 15036 936211 0 154267 6 0 1 0 CVS PHARMACY ONE CVS DRIVE WOONSOCKET RI 02895 PHARMACY DISPENSING FEE 398298 MCKESSON CORP 80 SAND ISLAND ACCESS ROAD HONOLULU HI 96819 PHARMACUTICAL SUPPLIES 323746 ZR SYSTEMS GROUP LLC 1953 S BERETANIA ST HONOLULU HI 96826 INFORMATION TECH SUPPORT 143221 3 181545 14409 4442699 2531623 7170276 MEDICAID 624110 3562837 3562837 PHARMACY 624110 1067210 1067210 PRIVATE INSURANCE 624110 888663 888663 MEDICARE 624110 209333 209333 SELF-PAY 624110 -505739 -505739 429841 429841 5652145 6468 6468 27222 14409 6230 20992 20992 OTHER INCOME AND FEES 624110 266076 266076 INCENTIVE PAYMENTS 624110 132357 132357 CARETAKER HOUSING 900099 873 873 399306 13249187 6051451 0 27460 X 589196 194955 394241 6443022 5594107 653568 195347 390317 342238 48079 1127215 962872 164343 550214 459002 91212 14489 14489 57831 57831 1358825 926989 431836 1431378 1326919 104459 173023 14024 158999 68594 58283 10311 855631 99540 756091 62504 5020 57484 REPAIRS AND MAINTENANCE 101771 59121 42650 DEVELOPMENT AND TRAININ 62923 50550 12373 EQUIPMENT RENTAL 49936 10949 38987 MISCELLANEOUS 37650 9778 27872 37242 15919 21323 13411761 10130266 3086148 195347 2292966 598386 836029 3221590 737392 986942 920539 418519 3980 746 17132516 6182465 11601556 10950051 16392462 16176234 1160117 1099336 997983 1005110 2158100 2104446 X 13947203 13880544 287159 191244 14234362 14071788 16392462 16176234 -162574 0 X X 0 1 X 1 1 1 X 9824923 6493263 5445476 5884053 7170276 34817991 9824923 6493263 5445476 5884053 7170276 34817991 34817991 6859 10053 2157 5784 6468 31321 20992 20992 25314 87532 187060 240687 399306 939899 35810203 25160347 0.97230 0.97240 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2288000 2288000 12603236 4501834 8101402 17500 17500 0 2098825 1663131 435694 124955 124955 10950051 X 13625971 364697 12087 376784 13249187 0 13249187 13876195 457174 7260 464434 13411761 0 13411761 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE UNCERTAIN TAX POSITIONS TO BE RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS IF THEY ARE MORE LIKELY THAN NOT TO FAIL UPON REGULATORY EXAMINATION. MANAGEMENT HAS ANALYZED THE COMPANY AND AFFILIATE'S TAX POSITIONS AND HAS CONCLUDED THAT AS OF JUNE 30, 2016 AND 2015, THERE WERE NO UNCERTAIN POSITIONS TAKEN OR EXPECT TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR ASSET OR REQUIRE DISCLOSURE IN THE COMBINED FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: REVENUE FROM KKV FOUNDATION (REPORTED SEPARATELY) 5,857. EXPENSES NOT RECORDED NET WITH FUNDRAISING EVENT INCOME 6,230. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES FROM KKV FOUNDATION (REPORTED SEPARATELY) 1,030. EXPENSES NOT RECORDED NET WITH FUNDRAISING EVENT INCOME 6,230. PART XI, LINE 2 - DONATED SERVICES AND USE OF FACILITIES CONTRIBUTED MEDICAL SUPPLIES: $328,200 CONTRIBUTED RENT: $36,487 PART XII, LINE 1 - DONATED SERVICES AND USE OF FACILITIES CONTRIBUTED MEDICAL SUPPLIES: $328,200 CONTRIBUTED RENT: $128,974 SECTION 1.263(A)-1(F) DE MINIMIS SAFE HARBOR ELECTION ------------------------------------------------------------------------ KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES 2239 NORTH SCHOOL STREET HONOLULU, HI 96819 TAXPAYER IDENTIFICATION NUMBER: 99-0149797 FOR THE YEAR ENDING JUNE 30, 2016 KOKUA KALIHI VALLEY COMPREHENSIVE FAMILY SERVICES IS MAKING THE DE MINIMIS SAFE HARBOR ELECTION UNDER REG. SEC. 1.263(A)-1(F). ------------------------------------------------------------------------ HOOULU AINA 41631 14409 27222 21 6209 41631 14409 27222 21 6209 6230 20992 X X X 0 0 0 0 0 0 0 0 0 DAVID DERAUF EXECUTIVE DIRECTOR 156682 0 0 0 0 0 13586 0 23996 0 194264 0 0 0 LAURA DEVILBISS CLINICAL DIRECTOR 160534 0 0 0 0 0 13645 0 5148 0 179327 0 0 0 JONAS NAVICKAS PHYSICIAN 130253 0 0 0 0 0 11219 0 10363 0 151835 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE EXECUTIVE DIRECTOR REVIEWS THE 990 IN CONJUNCTION WITH THE CFO BEFORE PRESENTING TO THE FINANCE COMMITTEE FOR REVIEW. THE FINANCE COMMITTEE REVIEWS THE 990 AND MAKES A RECOMMENDATION TO THE BOARD OF DIRECTORS FOR APPROVAL. FORM 990, PART VI, SECTION B, LINE 12C A COPY OF THIS POLICY IS GIVEN TO ALL BOARD MEMBERS UPON COMMENCEMENT OF SUCH PERSON'S RELATIONSHIP WITH THE ORGANIZATION. EACH BOARD MEMBER SIGNS AND DATES THE POLICY AT THE BEGINNING OF HER/HIS TERM OF SERVICE OR EMPLOYMENT AND EACH YEAR THEREAFTER. FAILURE TO SIGN DOES NOT NULLIFY THE POLICY. THE POLICY AND DISCLOSURE FORM MUST BE FILED ANNUALLY BY ALL SPECIFIED PARTIES. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE DIRECTOR'S SALARY IS DETERMINED BY THE BOARD OF DIRECTORS. ALL OTHER STAFF COMPENSATION IS DETERMINED BY THE SALARY COMMITTEE AND APPROVED BY THE EXECUTIVE DIRECTOR. THE BOARD OF DIRECTORS APPROVES THE STAFF SALARY SCALE. COMPARABLE DATA IS OBTAINED FROM HAWAII PRIMARY CARE ASSOCIATION AND HAWAII ALLIANCE OF NONPROFIT ORGANIZATIONS (HANO). THIS PROCESS IS DOCUMENTED IN THE SALARY COMMITTEE MINUTES AND HR RECORDS. THIS WAS LAST UNDERTAKEN IN JANUARY 2016. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 926,989. MANAGEMENT AND GENERAL EXPENSES 431,836. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,358,825. FORM 990, PART XII, LINE 2C: EXPLANATION: THE ORGANIZATION HAS NOT CHANGED EITHER ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR. KALIHI VALLEY COMMUNITY FOUNDATION 2239 NORTH SCHOOL STREET HONOLULU HI 96819 990329894 PROVIDE FINANCIAL SUPPORT TO CENTER HI 501(C)(3) LINE 7 KOKUA KALIHI VALLEY COMP FAMILY SVCS 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0